Women face multiple challenges when it comes to receiving contraceptive advice and access. Addressing this, helps to empower women and contributes to shaping a more equitable and safe South Africa, writes Dr Nomacete Tshume, a clinician at Kena Health.

 Contraception is a critical healthcare need that has a far-reaching impact on society. Giving women the ability to plan for children or prevent unplanned pregnancies has been shown to have positive economic and health-related consequences. This includes reducing the risk of complications among much younger and older women and bringing down the need for unsafe abortions and mother-to-child HIV transmissions, allowing women to participate better in society and work.

According to a National Department of Health indicator on contraceptive coverage, known as the “couple-year protection rate (CYPR), ” South Africa has recently seen a decline in contraception coverage. This is matched by a high unintended pregnancy rate (51.6% in a cross-regional survey conducted in 2019).

But, while contraception should be available to every South African woman who chooses to use it, many don’t receive the proper care and advice they need. There is no singular explanation for the decline in contraception coverage but several contributing factors.

The problem of awareness and education on contraception

Choosing the appropriate contraceptive method requires education and consultation with a healthcare professional. In many cases, though, South African women lack adequate knowledge about reproduction, conception, fertility and even how the various contraceptive methods work to make informed decisions.

This problem is worsened by the lack of counselling, and support women tend to receive from health care providers. Healthcare workers often don’t have sufficient training or time to advise and administer a wider range of contraception options, such as inserting and removing IUDs or implants. This, together with common misconceptions, means the same tried and tested contraceptive methods tend to be administered without considering each patient’s needs.

Social stigma around contraceptive use

Another issue women face when seeking contraceptive assistance in South Africa is societal taboos around women being sexually active. Young or unmarried women, in particular, can face judgement from their communities or healthcare providers alike. This can make visiting a clinic an unpleasant experience, often avoided.

Once a woman has decided on a contraceptive method, many forms of contraception require a prescription, frequent renewals and consultations with medical professionals. This adds to the time and costs it takes to access contraception. Women who are hesitant to visit public clinics are faced with long lines and occasional disruption in contraceptive supply.

Women in the private healthcare sector need to schedule appointments with healthcare professionals to review their prescriptions. Apart from the cost of consultation, contraception is not a prescribed minimum benefit as defined by the Council of Medical Schemes. This means that while some schemes will cover certain contraceptives, this tends to come out of a member’s savings account, and once those are depleted, options grow limited.

GBV and women’s vulnerability

Many women use contraceptives in South Africa due to the epidemic of Gender-Based Violence. For some, these contraceptives offer a way to avoid conflict with their partners around using a condom. In many other cases, women use pre-exposure prophylaxis PrEP to mitigate the threat of HIV contracted through rape.

Another common request for contraceptives is due to burst condoms, which should not occur as frequently as it is reported. In these cases, there may be an attempt to mask the truth due to shame, further worsened by the stigma patients receive when visiting clinics.

Answering the call for more accessible family planning and contraception

For the past several months, I’ve been consulting through the Kena Health app, a new app that allows people to chat with a registered doctor, nurse or mental health professional on their smartphone. 80% of our patients have been women, and almost a third of all consultations have been related to women’s health, specifically STIs and contraception — a testament to the need for such a service in South Africa.

All consultations are done using a smartphone, which helps address many issues women face in seeking contraceptive help. For one, there is a degree of anonymity as the consultations are private, conducted in each patient’s own time and space by registered clinicians who treat them with kindness. The affordable cost (R185 per consult) to chat with a registered nurse or doctor to advise on contraceptive methods and issue prescriptions. In other instances, where the patient is simply looking to renew their prescription, they can use our express consultation service, which only costs R120.

For too long, I’ve seen how vulnerable and exploited women are in this country. We need to find ways to address this through empowerment. In my experience, Kena is helping here, and every time I speak with someone who has struggled to receive proper advice or treatment, I’m reminded of this fact. Being able to speak to patients, often in their home language, over a video or voice call helps me to feel like I am making a difference. I feel enriched every time I listen to a woman in need of help, and show them that we care. – Health-e News